Surge 2021

First Name *

Last Name *

Mobile Number *

School *

School Year (2021) *

Date of Birth *

How did you hear about this event? *

Emergency Contact Full Name *

Emergency Contact Phone Number *

Emergency Contact Relationship *

Are there any Allergies or medical needs? Please list all. *

I consent to my child's photo/video being taken in which my child appears for use within the Summerfest program and the Lighthouse Church in general. *

Yes

No

I consent to allowing team leaders to provide panadol or Nurofen if required *

Yes

No

General admission 0